Cataract

Extraction
EYE DEPARTMENT MBBSMC
 Definitions
 ICCE
 ECCE
 ICCE e AC IOL
 ECCE e PC IOL
 MSICS e PC IOL
 PHACO e Foldable IOL
 The word “cataract” means “waterfall,”

 In 5th century BC (as determined from Sanskrit

manuscripts), the first cataract operation “couching”
was performed By Shustra

 This method consisted of pushing the lens, moving it

away from the pupil (visual axis), and letting it fall in the
vitreous cavity towards the rear and bottom of the eye
ball.
 in 29 A.D., a method called “needling” or “discussion”
was described in De Medicinae by Aulus Cornelius in
Rome This procedure slices the cataract into multiple
particles, allowing for them to be easily absorbed.

 in 1748 Jacques Daniel in Paris, performed first ECCE

 In early twentieth century Samuel Sharp of London

developed a strategy to extract the full unbroken lens
via an incision by placing pressure with his thumb. ICCE
(first ICCE)
 A huge breakthrough occurred in the 1940s in England
when Harold Ridley created the intraocular lens.

 In 1957, Barraquer of Spain used alpha-chymotrypsin to

enzymatically dissolve the zonules for removal of the
lens.

 In 1961, Krawicz of Poland introduced Cryo-surgery that

removed the lens with a tiny probe attached by
freezing a small area on the surface of the cataract.
 The most significant change
marked by the modern era was
the introduction of
phacoemulsification surgery in
1967 by Dr. Charles Kelman

 During the late 1840s general

anesthesia was introduced for
surgical procedures.
 In 1884, topical anesthesia in the
form of eye drops (cocaine) was
developed.
 Investigations
 Routine Blood CP, ESR, RBS,
 Urine RE
 Screening for Hepatitis B and C
 Bio-metery
 Any other investigation necessary due to the co-
existing medical disorder
Videos
Phacoemulsification
 Retro-bulbar Anesthesia/ Topical anesthesia
 Povidone-iodine painting of lids
 Draping
 Main incision with 3.2mm keratome
 Side port incisions with 1.2 mm side port
knife
 Injection of methylene blue in the AC
 Washing of AC and filling of AC with OVD
(methylcellulose)
 Capsulorrexhis
 Hydro-dissection / delineation
 Stop and chop phaco
 Removal of epi-nuclear cortex with simeco
cannula
 Implantation of foldable IOL
 Removal of OVD
 Injection of Miochol to miose the pupil
 Hydration of incisions to make them water tight
 Sub Conjunctival Injection of antibiotic / steroid
 Pad the eye
Complications
Due to Anesthetic (drug and
technique)
 Allergy to povidone –iodine solution
 Hypotension /Syncope (vaso-vagal) /
convulsions / death
 Perforation of eye ball / damage to orbital
structures
 Retro-bulbar hemorrhage
 Optic nerve damage
Complications-Intraoperative

 Sub-conjunctival
hemorrhage  Falling of nucleus /
 Corneal burn pieces in vitreous
 Iris trauma  Falling of IOL into the
 Irido-dialysis vitreous
 Extension of capsular  Supra-choroidal
tear hemorrhage
 Posterior capsular
rupture
Early Post Operative

 Striate keratitis
 Sub-conjunctival  Acute bacterial
hemorrhage Endophthalmitis
 Retained lens matter  CMO
 Raised IOP  Wound leak
 Wound leak and iris  High astigmatism
prolapose  Wrong powered IOL
 Decentered IOL
 Hyphema
late
 PCO
 Pupillary lens capture
 Vitreous loss related complications (endothelial
decompensation, CMO, persistent uveitis, UGH
syndrome, wick syndrome, RD, Glaucoma)
 Epithelial ingrowth
 Glaucoma
 Retinal detachment
 Chronic endophthalmitis